Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, UK.
Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
Br J Anaesth. 2021 May;126(5):985-995. doi: 10.1016/j.bja.2021.01.034. Epub 2021 Mar 24.
General anaesthesia is known to enhance inhibitory synaptic transmission to produce characteristic effects on the EEG and reduction in brain metabolism secondary to reduced neuronal activity. Evidence suggests that anaesthesia might have a direct effect on synaptic metabolic processes, and this relates to anaesthesia sensitivity. We explored elements of synaptic transmission looking for possible contributions to the anaesthetised EEG and how it may modulate anaesthesia sensitivity.
We developed a Hodgkin-Huxley-type neural network computer simulation capable of mimicking anaesthetic prolongation of gamma-aminobutyric acid (GABA)ergic inhibitory postsynaptic potentials (IPSPs), and capable of altering postsynaptic ion homeostasis and neurotransmitter recycling. We examined their interactions on simulated electrocorticography (sECoG), and compared these with published anaesthesia EEG spectra.
The sECoG spectra from the model were comparable with published normal awake EEG spectra. Prolongation of IPSP duration in the model caused inhibition of high frequencies and saturation of low frequencies with a peak in keeping with current evidence. IPSP prolongation alone was unable to reproduce alpha rhythms or the generalised increase in EEG power found with anaesthesia. Adding inhibition of postsynaptic ion homeostasis to IPSP prolongation helped retain alpha rhythms, increased sECoG power, and antagonised the slow-wave saturation peak in a dose-dependent fashion that appeared dependent on the postsynaptic membrane potential, providing a plausible mechanism for how metabolic changes can modulate anaesthesia sensitivity.
Our model suggests how metabolic processes can modulate anaesthesia and produce non-receptor dependent drug sensitivity.
全身麻醉会增强抑制性突触传递,从而在脑电图上产生特征性效应,并由于神经元活动减少而导致脑代谢降低。有证据表明,麻醉可能对突触代谢过程有直接影响,这与麻醉敏感性有关。我们研究了突触传递的各个方面,寻找可能对麻醉脑电图产生影响的因素,以及它如何调节麻醉敏感性。
我们开发了一种 Hodgkin-Huxley 型神经网络计算机模拟,能够模拟γ-氨基丁酸(GABA)能抑制性突触后电位(IPSP)的麻醉延长,并能够改变突触后离子稳态和神经递质再循环。我们检查了它们在模拟脑电图(sECoG)上的相互作用,并将其与已发表的麻醉脑电图频谱进行了比较。
模型的 sECoG 频谱与已发表的正常清醒脑电图频谱相当。模型中 IPSP 持续时间的延长导致高频抑制和低频饱和,峰值与当前证据一致。单独延长 IPSP 并不能复制 alpha 节律或麻醉时发现的 EEG 功率普遍增加。将 IPSP 延长与抑制突触后离子稳态相结合有助于保留 alpha 节律,增加 sECoG 功率,并以剂量依赖的方式拮抗慢波饱和峰值,这种方式似乎取决于突触后膜电位,为代谢变化如何调节麻醉敏感性提供了一种合理的机制。
我们的模型表明代谢过程如何调节麻醉并产生非受体依赖性药物敏感性。